Provider Demographics
NPI:1083442206
Name:INTEGRATIVE MEDICAL ASSOCIATES PLEASANT GROVE
Entity type:Organization
Organization Name:INTEGRATIVE MEDICAL ASSOCIATES PLEASANT GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-375-7100
Mailing Address - Street 1:3650 N UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6658
Mailing Address - Country:US
Mailing Address - Phone:801-375-7100
Mailing Address - Fax:
Practice Address - Street 1:10 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2630
Practice Address - Country:US
Practice Address - Phone:801-375-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care